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Care Transitions Coordinator

Company: Amedisys Home Health Services
Location: Hawthorne
Posted on: June 7, 2021

Job Description:

What You Will Do

The Care Transitions Coordinator is a clinical liaison position between health care providers to ensure continuity of care for patients transitioning from a facility to home care or hospice environment. The position has two separate and distinct general responsibilities: (1) following the receipt of a valid referral for home health or hospice services, directly communicating with and assessing the patient to improve the patient's transition from the inpatient to the home setting; and (2) developing the referral relationships of the agency within the community, in accordance with Amedisys policies and procedures.

  • After a patient has selected Amedisys as his or her health care provider, the Care Transitions Coordinator visits the patient onsite to review the physician order, assess the patient's clinical needs and gather clinical information.
  • The Care Transitions Coordinator uses a Point of Service computer application to collect referred patient data onsite and transmit it to the agency. The Care Transitions Coordinator also facilitates patient involvement in his or her own care by providing education and obtaining the necessary information required for successful transition to home.
  • The Care Transitions Coordinator is also responsible for ensuring the patient has a physician and obtains an order from that physician to oversee the home health plan of care.
  • Face to Face documentation must also be noted in Point of Service computer and communicated to appropriate care center.
  • The Care Transitions Coordinator is also responsible for establishing, growing and maintaining relationships with facility-based referral sources, in accordance with Company policies and procedures, by both communicating with existing referral sources and identifying new opportunities.
  • The Care Transitions Coordinator has a strong focus to help reduce ACH 30 day-hospitalizations.


  • Must meet one of the following qualifications:
  • Bachelor's degree with one (1 ) year successful experience in healthcare, business development, or related industry.
  • Successful previous experience in business development, outreach, or healthcare related role.
  • Current, unencumbered Registered Nurse or Licensed Practical Nurse license in the state of service. MSW, LCSW, PT, PTA, OT, OTA, SLP, and PA are considered in some cases.


  • Experience in Home Health or healthcare business development.

Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic.

Keywords: Amedisys Home Health Services, Yonkers , Care Transitions Coordinator, Other , Hawthorne, New York

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